Chemotherapy for lung cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. These drugs interfere with the way cancer cells grow and divide. They also affect normal cells. This causes side effects.

Your cancer doctor and nurse will talk to you about the aims of your treatment. Chemotherapy can be used along with other treatments or on its own.

The chemotherapy you have depends on:

• the type of lung cancer
• the stage of the cancer
• how side effects are likely to affect you.

Your doctor may talk to you about having chemotherapy as part of a clinical trial.

Chemotherapy is usually the first treatment for small cell lung cancer (SCLC). You may have it:

• at the same time as radiotherapy (chemoradiation), if the cancer has not spread to other parts of the body
• before radiotherapy to try to shrink the cancer
• on its own to control advanced cancer, help you live longer and improve symptoms.

Chemotherapy may also be given after surgery to try to get rid of any remaining cancer cells. But surgery is not usually possible for SCLC.

The chemotherapy drugs used for SCLC are usually cisplatin or carboplatin, along with a second chemotherapy drug such as etoposide.

If the cancer is small enough and you are well enough to cope with side effects, chemoradiation is the most effective treatment. If you cannot have both treatments at the same time, you can have chemotherapy first followed by radiotherapy.

At first, you usually have chemotherapy on its own. Some people may have it along with an immunotherapy drug, such as atezolizumab.

If chemotherapy has helped reduce the cancer you may have radiotherapy to the chest afterwards.

Your doctor may also talk to you about having radiotherapy to the brain to help prevent a secondary cancer. This is called prophylactic cranial radiotherapy (PCR).

If the cancer comes back or is growing, and you are well enough, you can usually have more chemotherapy with different drugs.

Your doctor may recommend a combination of the chemotherapy drugs cyclophosphamide, adriamycin, and vincristine (CAV). Or you may have a drug called topotecan instead of CAV. You take topotecan as a tablet.

Chemotherapy can be given in different ways, depending on your treatment plan. Your chemotherapy nurse will explain what is involved.

Usually chemotherapy is given in a chemotherapy day unit or outpatient clinic. But depending on the type of chemotherapy, some people may stay in hospital to have it.

Most of the drugs are given into a vein (intravenously). Some chemotherapy drugs, such as topotecan, are given as tablets.

A nurse gives you chemotherapy through a small tube (cannula) placed into a vein in your hand or arm. The drugs are given through a drip (infusion), or as an injection into the vein.

Some people have chemotherapy through a soft, plastic tube into a vein in their chest (called a central line). Or they may have it through a PICC line into a vein in their arm.

You have chemotherapy into the vein as 1 to 2 sessions of treatment, usually over 3 weeks. This makes up a cycle of chemotherapy. Each session will take a few hours.

Your doctor or nurse will explain more about this. You usually have 4 to 6 cycles of chemotherapy.

Chemotherapy drugs cause different side effects. These can usually be well controlled with medicines. Your doctor or nurse will tell you about the most likely side effects and how they can be controlled or managed. Most side effects usually go away once treatment has finished. 

We have more information about the side effects of chemotherapy.

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